Physicians Decry EHR Quality, Ask for Meaningful Use 3 Postponement

Thu, Jul 23, 2015 --

Compliance, EMR/EHR

EHR, EMR, Health Records, electronic health records

Now that it’s reached an accord of sorts with CMS on ICD-10, the AMA has turned its considerable resources towards amending the Meaningful Use program for electronic health records (EHRs), calling on CMS to postpone finalizing Stage 3 rules.

At a town hall meeting on July 20, hosted by AMA president Steven Stack, MD, Representative Tom Price, MD, of Georgia’s 6th Congressional District, and the Medical Association of Georgia, a stream of physicians talked about the current state of EHRs and Meaningful Use. “EHRs have so much potential to improve healthcare, quality, and patient engagement,” said Dr. Stack. “However, that is not the current state of reality.”

Though the overall goals for achieving meaningful use of electronic health records were appropriate and well intended, they have gone off track, said Rep. Price. In fact, he said, currently, “We are on the path to an unmeaningful and useless product.”

The initial goals of the Meaningful Use program were to spur physician adoption of electronic health records, and that goal has been met today, said Dr. Stack, because 80 percent of all physician practices in the U.S. use an EHR today. However, the AMA is alarmed at the way that EHRs often get between physicians and their patients. Worse yet, because EHRs do not readily share information with other practices, digital silos of information have replaced the old paper chart silos instead of allowing a free flow of patient information.

The AMA’s new campaign aims to get CMS to postpone finalizing stage 3 regulations so they can be aligned with other programs under the new Merit-based Incentive Payment System. Before increasing regulations on clinicians, regulators should fix the problems with EHRs, Dr. Stack said, including the way they have affected the quality of clinical documentation.

Clinicians Protest Poor EHR Documentation Quality

Kay Kirkpatrick, MD, an orthopedic surgeon with Resurgens Orthopaedics in Atlanta, said her practice adopted an EHR in 2006, believing that EHRs promised some big advantages, but documentation quality turned out to be poor. Instead of using the templates set up by the vendor, the practice returned to dictation and transcription. “We pay $21,000 per year per doctor for transcription because our notes are readable, and they relate to the care of the patient,” she said. “A lot of the templated notes that we get from other practices — I don’t want to use a word as strong as garbage, but that’s how a lot of it reads,” Dr. Kirkpatrick said.

Gary Botstein, MD, a rheumatologist in solo practice in Atlanta, said that he wrote his own electronic medical record (EMR, another term used for EHR) in 1994 in a relational database that he designed to take care of patients and speed his workflow. If your EHR requires you to input huge amounts of data, he said, it takes you away from patient care. Dr. Botstein said in the EHR he designed, documenting the care of a complex lupus patient required entry of 48 data points including vital signs, medication side effects, physical findings, symptoms, and potential complications. But when he purchased an ONC-certified EHR in 2011, it required entry of 280 distinct data points. He said that if he delegates history taking to a medical assistant (MA), that MA will be unable to pick up signals and interactions from patients that physicians are trained to discern. “If she asks, ‘Do you have chest pain?’ and the patient responds “Not really,’ the MA would check the box ‘no,’ but in reality, the patient is having angina,” Dr. Botstein said.

Disrupting Workflow, Flatlining Productivity

Dr. Stack said that he agrees with physicians who report that EHRs degrade office workflow. As a practicing emergency department physician, he said, the day his department went live on its EHR was cataclysmic. “It was like the way I had practiced medicine for 12 years was ripped out of my head, and I had to reinvent the whole way I organized, accessed, and used information and data,” Stack said. “It was the most singularly disruptive day in my medical practice.”

Many of the physicians who spoke were early adopters of EHR technology, including Melissa Rhodes, MD, a pulmonary critical care and sleep physician in the Atlanta area. She said that her three-physician practice adopted an EHR in 2006, and it never recovered its previous productivity levels. Even today, she said, “I see two-thirds the number of patients I used to see when I handwrote my charts.” Every night, every weekend, she said she is trying to catch up on her charts. And forget trying to get information from the charts of other clinicians. “Are records meaningful like they used to be? No,” Dr. Rhodes said. She has to wade through six-inch stacks of paper to find two sentences in the record that are helpful, she said.

E-Prescribing a Plus, but Interoperability Nonexistent

The clinicians agreed on some things that EHRs do well, including e-prescribing and giving easy access to records from remote locations such as home or a satellite office. But in addition to workflow disruptions, expense of purchase and maintenance, the poor quality of documentation, another problem is the lack of interoperability between record systems. The U.S. Senate’s Health, Education, Labor, and Pensions (HELP) Committee held hearings in June on EHR woes, with a focus on information blocking and lack of interoperability between systems.

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Susan taught health information and healthcare documentation at the community college level for more than 20 years. She has a special love for medical language and terminology. She is passionate about ensuring accurate patient healthcare documentation through education. She has a master's degree in healthcare administration, is a certified healthcare documentation specialist, and serves as immediate past president for the Association for Healthcare Documentation Integrity (AHDI).

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